评估 SPIKES 模型对内科学住院医师同伴反馈的影响：一项随机对照试验。

Evaluating the SPIKES Model for Improving Peer-to-Peer Feedback Among Internal Medicine Residents: a Randomized Controlled Trial.

机构信息

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.

Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

出版信息

J Gen Intern Med. 2021 Nov;36(11):3410-3416. doi: 10.1007/s11606-020-06459-w. Epub 2021 Jan 27.

DOI:10.1007/s11606-020-06459-w

PMID:33506399

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8606477/

Abstract

BACKGROUND

Feedback improves trainee clinical performance, but the optimal way to provide it remains unclear. Peer feedback offers unique advantages but comes with significant challenges including a lack of rigorously studied methods. The SPIKES framework is a communication tool adapted from the oncology and palliative care literature for teaching trainees how to lead difficult conversations.

OBJECTIVE

To determine if a brief educational intervention focused on the SPIKES framework improves peer feedback between internal medicine trainees on inpatient medicine services as compared to usual practice.

DESIGN

Randomized, controlled trial at an academic medical center during academic year 2017-2018.

PARTICIPANTS

Seventy-five PGY1 and 49 PGY2 internal medicine trainees were enrolled. PGY2s were randomized 1:1 to the intervention or control group.

INTERVENTION

The intervention entailed a 30-min, case-based didactic on the SPIKES framework followed by a refresher email on SPIKES sent to PGY2s before each inpatient medicine rotation. PGY1s were blinded as to which PGY2s underwent the training.

MAIN MEASURES

The primary outcome was PGY1 evaluation of the extent of feedback provided by PGY2s. Secondary outcomes included PGY1 report of feedback quality and PGY2 self-report of feedback quantity and quality. Outcomes were obtained via anonymous online survey and reported using a Likert scale with a range of one to four.

KEY RESULTS

PGY1s completed 207 surveys (51% response rate) and PGY2s completed 61 surveys (42% response rate). PGY1s reported a higher extent of feedback (2.5 vs 2.2; p = 0.02; Cohen's d = 0.31), more specific feedback (2.3 vs 2.0; p < 0.01; d = 0.33), and higher satisfaction with feedback (2.6 vs 2.2; p < 0.01; d = 0.47) from intervention PGY2s. There were no significant differences in PGY2 self-reported outcomes.

CONCLUSIONS

With modest implementation requirements and notable limitations, a brief educational intervention focused on SPIKES increased PGY1 perception of the extent, specificity, and satisfaction with feedback from PGY2s.

摘要

背景

反馈可以提高学员的临床表现，但提供反馈的最佳方式仍不清楚。同伴反馈提供了独特的优势，但也存在一些挑战，包括缺乏经过严格研究的方法。SPIKES 框架是一种从肿瘤学和姑息治疗文献中改编而来的沟通工具，用于教授学员如何领导困难的对话。

目的

确定在住院医师服务中，针对 SPIKES 框架的简短教育干预是否比常规实践更能提高内科住院医师之间的同伴反馈。

设计

在 2017-2018 学年期间，在一所学术医学中心进行的随机对照试验。

参与者

共纳入 75 名 PGY1 和 49 名 PGY2 内科住院医师。PGY2 被随机分为 1:1 的干预组或对照组。

干预措施

干预措施包括 30 分钟的基于案例的 SPIKES 框架教学，然后在每个住院医师轮转前向 PGY2 发送有关 SPIKES 的复习电子邮件。PGY1 对接受培训的 PGY2 不知情。

主要观察指标

主要结局是 PGY1 对 PGY2 提供反馈的程度的评估。次要结局包括 PGY1 对反馈质量的报告以及 PGY2 自我报告的反馈数量和质量。通过匿名在线调查获得结果，并使用 1 到 4 的李克特量表进行报告。

主要结果

PGY1 完成了 207 份调查（51%的回复率），PGY2 完成了 61 份调查（42%的回复率）。PGY1 报告说，干预组的 PGY2 提供的反馈程度更高（2.5 比 2.2；p = 0.02；Cohen's d = 0.31），更具体的反馈（2.3 比 2.0；p < 0.01；d = 0.33），以及对反馈的满意度更高（2.6 比 2.2；p < 0.01；d = 0.47）。PGY2 自我报告的结果没有显著差异。